MEDICARE: EDUARDO F VALDES DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	106790	CA

General Provider Information

NPI Number	:	1891469623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARDO F VALDES DDS

Provider Business Mailing Address
First Line	:	6568 BEACHVIEW DR APT 219
Second Line	:
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-6931
Country	:	US
Telephone Number	:	415-595-0196
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 DEEP VALLEY DR STE 347
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-7603
Country	:	US
Telephone Number	:	310-361-4535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	08/04/2021

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